August 12, 2009

Health Quote Debate Unquote

Filed under: awesome,future,interfaces,life,parenting,vendetta — mhoye @ 10:47 pm


So, our beloved neighbours to the south appear to having some sort of “debate” about heath care reform, in which they use the word “debate” in a way that is unfamiliar to me. As far as I can tell, the two sides consist of:

  1. people who think that all Americans should have a reasonable level of publicly funded health care, and
  2. a shrieking legion of exorbitant liars, paranoid, ignorant right-wing bigots and a small army of well-funded insurance-industry carrion vultures

… and they are not exactly engaged in what you might call a measured discussion of the technical details of various policy options. Feel free to act surprised.

There is never, I think, a bad time to re-read the D-Squared Digest One-Minute MBA, one of the great blog posts of all time, in this instance with an emphasis on the first third of the course. But permit me to embellish that link with my own views on the subject; herewith, my American friends, is a short list of some of the things I never have to do or even think about much here in our cold, grey socialist hellhole of Canuckistanislavia.

  • I am never afraid of what it means if the headache won’t go away.
  • I never worry about whether or not something is covered, ever.
  • I have never had to lie to a doctor because an unrelated preexisting condition might mean voiding my insurance and its coverage of my current problem.
  • I am never stuck in a job I hate because of the fear losing my health coverage.
  • I never have to fight with insurance companies about how much of whatever treatment they’ll pay.
  • It never even occurs to me to wonder how we’ll make ends meet if my wife or I get sick.
  • I am never afraid of losing my home or business because of medical bills.

There are literally hundreds of other things I don’t do, with regards to my health care, but the most important thing I never do is this:

  • I do not live in fear.

My daughter’s birth was far, far more exciting than it needed to be. For a couple of hours there I thought I was coming home alone. But after three days in intensive care for both of them, in which a team of absolutely first-rate professional medical staff used the finest, most modern tools and techniques at their disposal, I got to go back to a home I could still afford with a recovering wife and child. The paperwork I received a few weeks later included information on how to apply for a birth certificate, some other government paperwork, and a bill for the private room we chose so that I could stay with them instead of having to go home at night.

I think it cost me $80. That and parking.

I pay a lot more than that, of course, year over year in taxes. And while I quibble (as all responsible citizens should!) about the details of how my taxes get used, let me tell you: single-payer, socialized medicine is absolutely fucking fantastic. Not being terrified of the bill coming due for that nightmare at all, being able to give my wife and child 100% of my attention when they need it most, it is gold.

As far as I’m concerned not having reliable, government-supported medical care is precisely the same as not having clean running water or electricity. It’s a sign that you’re far, far outside the bounds of civilization, in some godforsaken backwater where people live with their necks under the jackboot of random chance, where the barbarians are winning.


  1. And yet if you try to actually have this precise conversation with many (certainly not all) Americans, providing real life evidence of how the system doesn’t actually suck, they often act as if you’re a bit soft in the head and don’t know what you’re on about. I’m really not sure what it takes.

    Comment by dria — August 12, 2009 @ 11:33 pm

  2. Having your coverage discontinued, I think.

    Comment by mhoye — August 12, 2009 @ 11:48 pm

  3. Or, as one cynical political comment goes: in the United States, nothing turns a conservative into a liberal like having a sick child with private health insurance — or no health insurance at all.

    That’s why health insurance reform will someday pass in America. Because no matter how much money the private insurance companies spend in lobbying — and they’ve already spent almost as much money as both presidential candidates in 2004 spent — they can’t change what millions of Americans experience every year. Every time, every day, an American gets screwed by the for-profit insurance industry, reform gets one more vote.

    Someday, reform will pass no matter how much the insurance industry spends. The only question is how many Americans have to suffer before it does.

    Comment by Jeff — August 13, 2009 @ 12:20 am

  4. I’ll be honest, my big issue is not with single-payer health care as such.

    My problem is with single-payer health care drafted by Congress and forced upon the entire nation.

    The only thing about modern US politics that genuinely surprises me is that, in a country in which virtually _everyone_ complains that the nation is too polarized, those same people insist on setting policy at a national level.

    Few are content simply to do things right in their own state, be an attractive place to live, and compete in the marketplace of ideas. Few are willing to let people who disagree live their own lives. Few are content to let California have single-payer care, and let New Hampshire keep on keepin’ on. If You Don’t Do It My Way, You’re A Lying, Paranoid, Ignorant, Right-wing Bigot.

    And as all of the money goes Federal, so too goes the control, for SCOTUS agrees that Congress can impose virtually any unconstitutional law on the states simply by making it a condition of an appropriation.

    Frankly, I would much rather have no government health scheme than a Federal one; there is simply no debate in my mind. It is so staggeringly out of the Federal government’s Constitutional scope, not to mention poor policy for such a diverse republic.

    I know you don’t agree, but I’m ok with that too. I’ve been called worse.


    Comment by phik — August 13, 2009 @ 5:39 am

  5. While I don’t think you’re a paranoid, right wing bigot, I also don’t think your views are anything like the overwhelming majority of rhetoric being expounded on that side of the aisle.

    I also think that your strict conservatism with respect to the separation of state and federal powers is somewhat disappointingly antiquated. I don’t doubt your good intentions, but you must be aware that the “State’s Rights” flag is not one that’s often hoisted by people with noble goals.

    And, finally, I think you can often discern the merits of an idea by the company it keeps. Particularly when the finer technical details of that idea, rather than the broad scope of it, are going to be implemented or bought by those companies. And in this case, the collection of talk show hosts, corporate shills and cartoonishly ignorant politicians coming out against single payer health care is prima facie evidence that it is, in fact, a very good idea.

    Comment by mhoye — August 13, 2009 @ 8:21 am

  6. Tragically, of course, single-payer is on nobody’s agenda. The closest thing to single-payer that’s being proposed is that for people who aren’t covered under an employer-based plan, they’ll have a choice of plans to choose from, one of which may be run by the government. But it looks right now like that’s too radical, and probably we won’t have that option even if something passes.

    Comment by Mike Kozlowski — August 13, 2009 @ 9:12 am

  7. I don’t see much of the coverage from this side of the world, but no, I don’t doubt for a moment that there is a lot of asinine rhetoric.

    (Though as an aside, I am also more than cynical enough to believe that some media are willing to cherry pick the most ignorant, partisan sound bites, in the dual interests of “good TV” and maligning the opposition. That the intelligent debate doesn’t rise to the top in a media market dominated by shows like Hardball should surprise nobody.)

    On the other hand, I’m disappointed that you view local-er government as antiquated. Apart from arguments of efficiency — and frankly, government efficiency terrifies me, another way in which I suspect we differ — I don’t understand how government being closer to the citizen is a bad thing. Who is harmed by letting smaller groups govern themselves in the way that pleases them? Apart from corporations of sufficient girth, who benefits from the opposite?

    I’m also perplexed by the statement that the principle of state’s rights has somehow been ruined by association with distasteful causes. I’m not sure which ignoble goals you refer to, but in any case, I don’t see how they’re relevant to the discussion.

    While I certainly agree that one should almost reflexively campaign for the opposite of whatever an insurance company, talk show host, or politician is advocating — I have the same policy when it comes to teachers unions — it slays me to see this whole issue boiled down to the false choice of either keeping our horrendously broken system or letting Washington make another huge power grab. When they grab, it’s with both hands; you don’t get that back.

    Is attempting to govern at this scale — to assume you’re going to get it right for the whole country, on the first try, and preempt the people from trying anything else — not the very pinnacle of hubris?

    Comment by phik — August 13, 2009 @ 9:14 am

  8. I agree that the safety net that the Canadian healthcare system provides is a fundamental benefit to worker mobility (though provincial differences do make it easier or harder for people with certain conditions to live in certain areas) which makes life easier for Canadians. However, I think it’s important to realize that as presently administered, the system is best suited to cover emergencies and regular checkups; the things that as you say, would otherwise strike fear into the hearts of citizens.

    Chronic conditions requiring prescription drugs, or non-critical injuries, are not as well covered (to whit: my friend Graeme had to wait more than 3 months for a MRI after dislocating his knee, mental health issues go without any real form of coverage, prescription drug costs for arthritic conditions can break a man). This is better than those services being completely unavailable, true, but there are ways to alleviate strain on the system, I think, without fully destroying it as some of the hysterical left wing proponents of health care would have you believe. In fact, many Canadians already do this in the form of supplementary health insurance, provided by their companies or their own pockets. This is not “two-tier” healthcare, this is people with money choosing to spend it on themselves in order to better their lives. It’s somewhat like buying a PVR, but a touch lower down on Maslow’s hierarchy.

    Specifically on point for healthcare in the USA, though, the currently proposed bill is a mess which only accomplishes one thing: it allows people to say that they have medicare. I do not think it emulates the Canadian system one bit, really, as it would not be the case that you wouldn’t have to fight for insurance money, you would likely still hide previous conditions (to avoid hassles), etc. If the US is truly interested in socializing their system, they need to address the tax code which basically ensures that employers will act as the primary cost coverage system for healthcare.

    Comment by Mike Beltzner — August 13, 2009 @ 9:47 am

  9. I certainly agree with Beltzner that the long-term care of chronic conditions is something we don’t do well.

    But Phik, when you ask “Who is harmed by letting smaller groups govern themselves in the way that pleases them?” Man, that’s why Goldwater’s only victories during his failed presidential campaign came from the deep south. He advocated letting states govern themselves in a way that pleased them, which in their case meant “segregation and oppression”. That’s just one of many examples I could bring to bear, here; “states’ rights”. Proposition 14 is another. The answer to “who is harmed…” is “anyone who does not wield power”. Whatever your personal intent, since the well before the Civil War “States’ Rights” arguments are historically symptomatic of groups who wish to advance unjust causes.

    You’re surprised that this issue is being boiled down to a “false choice”, but it’s not a false choice at all. It’s a choice between broad public welfare or profit motive as your driving incentive for the most basic levels of service delivery. And, as we’ve seen, “profit motive” in a field where people are likely to get sick, die, or be arbitrarily denied coverage over time is a field just riddled with perverse incentives to delay or deny care, with real human cost.

    But perhaps more to the point, I fundamentally find the idea of letting people suffer the full, unfettered consequences of accident or misfortune entirely on their own to be repulsive. It’s antithetical to the whole reason we have a society in the first place; it’s better, on average, than the arbitrary cruelties of random chance. The well-being of my neighbors and community affects me, personally, in thousands of little ways every day, and whatever the state of my own affairs it serves me well that I do not live amidst desperation.

    Comment by mhoye — August 13, 2009 @ 10:31 am

  10. Not to nitpick, but our Canadian national healthcare plan is in fact 13 connected provincial and territorial systems. There are basic standards covered in each system, but there are nuances between what the provinces offer (like I think things like eye exams are available in some provinces and not in others, but don’t quote me on that exact example) and some differing taxation as well (like in Ontario, we get an extra healthcare tax each year, cause it’s just like that).

    Health Canada works with the provinces to set guidelines, etc, but the brunt of healthcare resourcing and funding sits at the provincial level.

    Don’t know if that helps any of you with the problems with a national healthcare system and state’s rights.

    Comment by Chelsea Novak — August 13, 2009 @ 10:44 am

  11. I get it: when the states are free to make policy, those not in power get the shaft. So the answer, of course, is to legislate nationally, where the same somehow doesn’t apply?

    I hear your point, so before we agree to disagree, I guess I’ll try to summarise mine.

    My point is that I’m willing to admit that I don’t know what’s best for everyone, and that there’s more than enough room in America for all of us.

    I think we largely agree, certainly at the macro level, on the kind of health policy that we want for the places we live. I’m just not willing to use force to apply it to the whole country, and I think it’s clear that there are large swathes of America that don’t want it. If you ask me, to believe that a few dozen elites are going to make the right choices on an issue this complex and divisive is arrogance in the extreme.

    Would I prefer to live in a state with a broad level of basic care provided to all citizens and legal immigrants? I surely would. Do I mind if Texans decide otherwise? Of course not. Who am I to tell them how to run Texas?

    Maybe that makes me a monster. A humble monster, at least.

    Comment by phik — August 13, 2009 @ 11:09 am

  12. I’ve written quite a bit on this topic lately and I’m frankly too “written-out” to make many arguments… however I think the most telling thing is this:

    Any Canadian readers who go down to the states and watch television or listen to the radio will be shocked at how much advertising there is for drugs and other medical procedures. It’s just plain weird coming from Canada.

    To the American readers. I dare you. I dare you to count how many commercials for drugs, medical procedures or other healthcare “products” you see in one hour.
    Take that number and compare it to the the roughly 0.3 I just counted in various Canadian media (I included health insurance, but didn’t actually see any).

    Now I dare you to actually think about what you have been hearing on the subject… you might find that you start considering that all the hocus-pocus you’ve been hearing is coming from folks who have a vested interest in maintaining the status-quo.

    To most of us Canadians, your system looks positively barbaric.

    Comment by BP — August 13, 2009 @ 2:36 pm

  13. To be fair, advertising for drugs in Canada is very different than it is in the US. You may be seeing drug ads in Canada and not knowing that they’re drug ads since the advertising laws prohibit drug ads from mentioning the name of the drug in an ad. They can only mention what they drug does or vice versa, but not both.

    Again, just an FYI.

    Comment by Chelsea Novak — August 13, 2009 @ 4:10 pm

  14. One could write a book about the differences – good, bad and indifferent – between health expense coverage and access to health care in Canada and the US. My “comment” turned into a blog post of its own: Some Thoughts On Health Care Debate.

    Comment by janice — August 13, 2009 @ 7:36 pm

  15. The whole topic of health reform is messy. Especially given the fundamentals: cut costs, expand coverage, embrace health care as something that has nothing to do with profit, and everything to do with value. These three things must be done. The rhetoric suggests none will happen any time soon.

    Comment by Mark — August 15, 2009 @ 1:17 am

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